| NPI | 1659759330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD18218) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A161050) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2023-03-10 |